Complete Health Indicator Report of Gonorrhea Cases

Definition

Rate of newly reported cases of gonorrhea by date of diagnosis per 100,000 population.

Numerator

Number of newly reported cases of gonorrhea by date of diagnosis.

Denominator

Number of persons in Utah.

Data Interpretation Issues

Reported gonorrhea rates are calculated by dividing the number of cases within the population of interest by the total number of persons within that population, then multiplying by 100,000. It should be noted that because of the relatively small number of gonorrhea infections reported in Utah, rates can be volatile: a small change in the number of cases can noticeably change the rate. This change may look significant, but, statistically, it may not be. Caution is strongly recommended when interpreting small case numbers and rates.

Why Is This Important?

Although much less common than chlamydia infections, gonorrhea, caused by the bacterium ''Neisseria gonorrhoeae'', is a priority public health concern in Utah. Untreated gonorrhea infections can damage the reproductive systems of both males and females. Females with gonorrhea infection are at risk for developing pelvic inflammatory disease (PID), and both men and women may become infertile as a result of untreated gonorrhea infections. Also, susceptibility to infections such as HIV also increases when an individual has gonorrhea. Furthermore, pregnant women with gonorrhea can pass the infection to their infant during delivery, potentially resulting in ophthalmia neonatorum. Gonorrhea can spread to joints and become systemic (disseminated gonorrhea). In addition to the cervix and urethra, the rectum and pharynx are also possible sites of gonococcal infection.

Healthy People Objective STD-6:

Reduce gonorrhea ratesU.S. Target: Not applicable, see subobjectives in this category

How Are We Doing?

Following a doubling of Utah's gonorrhea rate from 2003 to 2006, when the rate peaked at 35.2 cases per 100,000 persons, Utah's gonorrhea rate decreased annually to the lowest reported rate of 9.8 in 2011. From 2011 to 2017, gonorrhea rates increased 728.6% to 81.9 cases per 100,000 persons.
In 2017, gonorrhea rates in the state were higher in males (107.1 cases per 100,000 persons) than in females (56.4 cases per 100,000 persons). Rates in females increased 1,100.0% from 2011-2017, compared to 618.8% among males during the same time frame. In 2016 rates of gonorrhea in males increased 28.7% while rates of gonorrhea in females increased 38.8%. Rates increased in both males and females in 2017, 19.5% and 18.7%, respectively.
The highest rates of gonorrhea in Utah in 2017 were among males aged 25 to 29 (317.1 cases per 100,000 persons) and males aged 20 to 24 (275.1 cases per 100,000 persons).

How Do We Compare With the U.S.?

Gonorrhea rates in Utah are well below rates in the U.S. In 2017, Utah's gonorrhea rate ranked 43rd highest in the nation. The overall rate for gonorrhea in the U.S. in 2017 was 171.9 cases per 100,000 persons.
Nationally in 2017, gonorrhea rates were higher in males (202.5 cases per 100,000 persons) than females (141.8 cases per 100,000 persons). Gonorrhea rates were highest among males aged 20 to 24 (705.2 cases per 100,000 persons) and females aged 20 to 24 (684.8 cases per 100,000 persons). The next highest groups were males aged 25 to 29 (645.9 cases per 100,000 persons) and females aged 15 to 19 (557.4 cases per 100,000 persons). (CDC. [http://www.cdc.gov/std/stats17 ''Sexually Transmitted Disease Surveillance''], 2017)

What Is Being Done?

Persons who test positive for gonorrhea are confidentially interviewed by a disease intervention specialist from a local health department to educate the patient, ensure proper treatment, and to obtain sexual partner information for follow up. This process potentially prevents the spread of infection and reduces the likelihood of the patient becoming reinfected. The Centers for Disease Control and Prevention currently recommends that patients with gonococcal infections be treated with a dual antibiotic therapy that is effective against chlamydia to simultaneously treat this frequent coinfection, improve gonorrhea treatment efficacy, and potentially slow the emergence of resistance to cephalosporins.
The Utah Department of Health Communicable Disease Prevention Program, along with local health departments, currently provide STD presentations upon request to a variety of organizations, agencies, and facilities.

Available Services

Local health districts have STD (sexually transmitted disease) clinics located at their local health department where adolescents can be tested and treated for STDs at minimal or no cost. Planned Parenthood has locations throughout Utah that also provide STD services at minimal cost. Condoms are available at these locations free of cost.
STD presentations are available through the Utah Department of Health upon request. The Utah Department of Health also has educational pamphlets available.
The Utah Minor's Consent Law allows adolescents between the ages of 14 and 17 years to be tested and treated for an STD without the consent of a parent.

Related Indicators

Relevant Population Characteristics

In Utah from 2000 to 2017, gonorrhea rates among males have consistently been higher than among females. In 2017, gonorrhea rates in Utah were highest among males aged 25 to 29 (317.1 cases per 100,000 persons) and 20 to 24 (275.1 cases per 100,000 persons). Among females, the highest gonorrhea rate was among 20 to 24 year olds (170.3 cases per 100,000 persons). In 2017, 38.0% of the male gonorrhea cases were reported to be among men who have sex with men (MSM). This may be an underestimate as data on sexual exposure was unavailable for 28.0% of male gonorrhea cases.

Related Relevant Population Characteristics Indicators:

Health Care System Factors

Gonorrhea may be reported more frequently in men than women because most infections in men produce symptoms that cause them to seek testing and treatment, while infections in women may not produce significant symptoms until complications develop (e.g. PID). Dual chlamydia/gonorrhea testing technology has improved reported rates of both infections.

Risk Factors

Risk factors for sexually transmitted diseases include:
* sexual activity among young adults 25 and younger
* multiple sex partners
* prior history of STDs
* unprotected sex
* illicit drug use.
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Those who fall within one or more of these categories should be tested for STDs in regular intervals. Sites of infection may include pharynx, rectum, vagina, cervix, and urethra.

Related Risk Factors Indicators:

Health Status Outcomes

Untreated gonorrhea in women may advance to PID (pelvic inflammatory disease), resulting in an increased likelihood of ectopic pregnancy, preterm delivery, or infertility. Untreated gonorrhea in men may result in infertility. Furthermore, pregnant women with gonorrhea can pass the infection to their infant during delivery, potentially resulting in ophthalmia neonatorum. Gonorrhea can spread to joints and become systemic (disseminated gonorrhea).

Data Notes

Rates were calculated by dividing the number of cases for each year by the total population within that year and multiplying by 100,000. Prior to 2009, Utah rates were calculated using the morbidity report date; effective 2009, rates were calculated using the date of diagnosis.

Data Sources

Utah Department of Health, Bureau of Epidemiology

National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention

Population Estimates: National Center for Health Statistics (NCHS) through a collaborative agreement with the U.S. Census Bureau, IBIS Version 2017

Data Notes

Rates were calculated by dividing the number of cases for each age/gender group by the total population within that group and multiplying by 100,000.

Data Sources

Utah Department of Health, Bureau of Epidemiology

Population Estimates: National Center for Health Statistics (NCHS) through a collaborative agreement with the U.S. Census Bureau, IBIS Version 2017

Gonorrhea by Race/Ethnicity, Utah, 2017

Race/Ethnicity

Cases per 100,000 Persons

Record Count: 7

American Indian, Alaskan Native

101.3

Asian

53.0

Black, African American

545.6

Hispanic, Latino

132.2

White, Non-Hispanic

60.6

Native Hawaiian, Pacific Islander

164.0

Two or More Races

23.5

Data Notes

Rates were calculated by dividing the number of cases within a race/ethnicity group by the population within that group and multiplying by 100,000.

Data Sources

Utah Department of Health, Bureau of Epidemiology

Population Estimates by Age, Sex, Race, and Hispanic Origin for Counties in Utah, U.S. Bureau of the Census, IBIS Version 2017

Gonorrhea by Local Health District, Utah, 2017

Local Health District

Cases per 100,000 Population

Record Count: 15

Bear River

26.5

Central

15.1

Davis County

52.1

Salt Lake County

142.2

San Juan

45.6

Southeast

42.5

Southwest

39.0

Summit

19.5

Tooele

63.7

TriCounty

19.6

Utah County

32.3

Wasatch

21.8

Weber-Morgan

99.4

State of Utah

81.9

U.S.

171.9

Data Notes

Rates were calculated by dividing the number of cases within a local health district by the total population in that district and multiplying by 100,000.

Data Sources

Utah Department of Health, Bureau of Epidemiology

Population Estimates: National Center for Health Statistics (NCHS) through a collaborative agreement with the U.S. Census Bureau, IBIS Version 2017

References and Community Resources

Fact sheets for communicable diseases may be found on the Bureau of Epidemiology website [http://health.utah.gov/epi/diseases/gonorrhea/factsheet.pdf/].
Other STD resources are available on the Bureau of Epidemiology website [http://health.utah.gov/epi/prevention/].
Screening Guidelines [http://www.cdc.gov/std/tg2015/screening-recommendations.htm].
Centers for Disease Control and Prevention, Division of Sexually Transmitted Disease Prevention website [http://www.cdc.gov/std].
Centers for Disease Control and Prevention. ''Sexually Transmitted Disease Surveillance 2017''. Atlanta, GA: U.S. Department of Health and Human Services; 2017. [http://www.cdc.gov/std/stats17/].
Centers for Disease Control and Prevention. 2015 Sexually Transmitted Disease Treatment Guidelines [http://www.cdc.gov/std/treatment].

More Resources and Links

Evidence-based community health improvement ideas and interventions may be found at the following sites:

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